In Reply:—

I thank Dr. Anand for bringing to the attention of the readers of Anesthesiology more complications related to sequential compression devices (SCD) used as prophylaxis against development of deep venous thrombosis.

Regarding complications associated with the use of SCD, such as leg compartment syndrome, common peroneal nerve injury, and others, we believe that, based on the nature of the device, certain patients will experience complications. This prompts us to improve the quality of devices and techniques to make them safer for our patients. Although clinicians should consider these remote complications when they prescribe use of the device, these complications are not life threatening or the cause of immediate concern to anesthesiologists who care for emergency surgery patients.

In his letter, Dr. Anand raised an interesting point in reference to a study by Cisek and Walsh. 1He wonders if SCD could be a factor in the higher incidence of thromboembolic complications in the patients who underwent retropubic radical prostatectomy. In our case report, 2we reported a patient who had multiple risk factors for deep venous thrombosis but was asymptomatic, and we suspect that SCD might have been involved in the dislodgment of already established thrombi. An argument can be made against Dr. Anand’s concern that SCDs could have played a part in the development of deep venous thrombosis because most retropubic radical prostatectomy patients undergo elective surgery, and the disease process (operable tumor) itself is not a risk factor for deep venous thrombosis. The study suggests increased incidence of thromboembolic complications in patients who had SCDs on their legs; however, it is difficult to establish a causal relation between these devices and the etiology of deep venous thrombosis. This study shows that SCDs delay thromboembolic complications. Most patients in the Cisek and Walsh study experienced these complications after discharge from the hospital.

Cisek LJ, Walsh PC: Thromboembolic complications following retropubic prostatectomy: Influence of external pneumatic compression devices. Urology 1993; 42: 406–8
Siddiqui AU, Buchman TG, Hotchkiss RS: Pulmonary embolism as a consequence of applying sequential compression device on legs of a patient asymptomatic of deep vein thrombosis. A nesthesiology 2000; 92: 880–2